The Man in the Mirror

Last night, I woke up a little before 3 a.m. and tested my blood glucose. It was 52. I had to get up and eat. Here I am, going to Weight Watchers, exercising, trying to take off another 15 pounds, and my efforts are being thwarted by diabetes.

It isn’t easy to lose weight under any circumstances. If you have diabetes, it can be even more difficult. If you take insulin or an oral medication that can cause your blood-glucose levels to go low, you’re often forced to eat—even when you don’t want to. (How many people do you know who have to get up at 3 a.m. and eat something?) Last night I probably consumed 500 extra calories that I didn’t need, just to get my blood glucose back up.

Many oral medications taken by people with type 2 diabetes actually promote weight gain. And yet we’re all told that we need to lose weight or, at least, avoid gaining weight.

When we don’t lose, or when we’re slow to lose, we feel like failures. At least I do. For example, I’ve lost only 11 pounds since I started Weight Watchers last October. My wife tells me I am not a failure; instead, because I am still going to the meetings, she says, "You are patient." I like her view better!

As people with diabetes, we’re supposed to eat "sensibly"—while being bombarded with billboards, magazine ads and television commercials that attack our senses with mouth-watering examples of (usually) fat-filled foods.

And there’s senseless eating. We went to a Cinco de Mayo party where there were candy-filled pinatas for the children to break. On our way home, my daughter, Miranda, would take one bite from each candy and then hand me the rest. I think she wanted to taste them all. My desire for chocolate overrode my commitment to avoid extra calories. I happily ate them.

I also find that I tend to nibble and taste while fixing my children’s school lunches and snacks. On the days when they have baseball practice after school, I have to fix double lunches.

Maybe I should be more accepting of myself. Maybe I should realize that I can only do my best and stop berating myself for taking a nibble here and there and for sometimes giving in to my. well, human qualities.

I can identify with many of the comments made by people in our article "Winning or Losing?" on page 32 of this issue. Many of us are told to "lose weight" but aren’t told how to lose it.

I think the first key is to realize the challenge—weight loss is tough, and everybody struggles with it.

The second key is to be patient with yourself.

P.S.: When I submitted this column to our clinical adviser, Cindy Onufer, RN, MA, CDE, she sent back a valuable comment that I want to share in its entirety.

Clinical adviser’s note: What concerns me is your comment that "…I probably consumed 500 extra calories that I didn’t need, just to get my blood glucose back up." Of course, when having a low at the most vulnerable time, the middle of the night, most people consume extra, just to be sure it’s safe to go back to sleep—to "carry them over." But for immediate treatment of blood glucose between 50 and 70 mg/dl, the American Diabetes Association recommends eating or drinking 15 grams of carbohydrate, which should raise the blood-glucose level 30 to 45 mg/dl. If blood glucose is near or less than 50 mg/dl, the ADA recommends consuming 20 to 30 grams of carbohydrate. But after 50 minutes, blood-glucose levels start to fall again.

The best action is to test blood glucose again about 15 to 20 minutes after treatment, and if the result is still low (70 mg/dl or less), repeat the treatment even if symptoms have disappeared. The catch is that if a meal or snack is not scheduled within the next hour (we’re talking 3 a.m. here!), then a more substantial snack is probably indicated (but not usually 500 calories).

The key is to be a detective and figure out why the low occurred. If it was a late response to exercise, then in the future either lower insulin to compensate for exercise or at least plan a healthy bedtime snack to prevent a low. Other thoughts are to consider whether the basal insulin dose is too high—try planning a 2:30 or 3:00 a.m. blood-glucose check to evaluate. For some people, for example, nighttime lows are related to alcohol intake. Or they might result from a "correction dose" late in the evening with rapid-acting insulin that was an overestimation.

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